Hydration and nutrition care practices in stroke: findings from the UK and Australia

Background Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients’ post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS). Aim To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia. Methods A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times. Results We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%). Conclusion Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-023-01575-4.


Section 2
Hospital and stroke service characteristics.

What category below best describes your hospital setting?
Tertiary referral, University or Teaching Hospital Non-tertiary, General, District or Community Hospital -with Emergency Department Non-tertiary, General, District or Community Hospital -without Emergency Department Other, please specify:_______________________________________________ 9. Please tell us about your stroke service: (Please select one only) We have a dedicated stroke unit with clinicians who have stroke expertise We do not have a dedicated stroke unit, but ward(s) with stroke beds We are a free-standing rehabilitation hospital (go to question 11) This section is about assessment and provision of oral care for stroke patients who are in your stroke unit or ward.

Does your ward or unit use an oral care assessment tool?
Please tick all that apply.

No tool used
The Holistic and Reliable Oral Assessment Tool (THROAT) fluid replacement is required, which approach would most often be used for each of the two patient populations shown in the table below?Please tick one option for each column.

. Please tell us about your rehabilitation service (Please select one only)
Rehabilitation ward within acute hospital in same building of same health campus Rehabilitation ward within acute hospital in separate buildings of same health campus

health care practices for patients with stroke.
This section focuses on oral health care practices for patients with stroke in your stroke unit or ward.This section is not about swallow screening protocols.

Have staff working at your hospital received training in oral care provision in the last year? Yes
No (go to question 16)Unsure (go to question 16) A 14.

20. Which dental professionals provide this help? Please tick all that apply.
ASection 4Assessment of oral health care practices for stroke patients.

How likely would an oral care assessment be undertaken at the following times? Please tick one box on each line. Frequency of assessment
Oral Cavity Assessment Tool (OCAT) Lockwood's Oral Health Assessment Tool (LOHAT) Beck Oral Assessment Scale (BOAS) Oral Assessment and Intervention tool (OAIT) Geriatric Oral Health Assessment Scale (GOHAI) Brief Oral Health Status Examination (BOHSE) Oral Assessment Guide (OAG) Rattenbury, Mooney, Bowen Mouth Assessment Tool (RMBMAT) Mouth Care Assessment Tool (MCAT) Daily oral health assessment (DOHA) Local area/hospital specific tool Unsure Other, please specify:_____________________________________ A 22.

How likely are the following professional groups to conduct an oral care assessment? Please tick one box for each professional group. Professional group
A 25.

a patient is incapable of independent oral care, are family or carers (non-professionals) encouraged to provide oral care to patients with acute stroke? Yes
No (go to question 28) Unsure (go to question 28) A 27.

Where are oral health care practices documented and how likely are they to be documented? Please tick one box for each document type.
A 33.

What aspects of oral health care are documented and how likely are they to be documented? Please tick one box for each oral care element.
This section is about the equipment and resources available on your unit or ward to facilitate and support oral care for patients with stroke.

. Which of the following are available for patients with a dry mouth? Please tick all that apply.
This section focuses on your views about potential barriers to providing oral care to stroke patients.37.